The Charitable Organization “Ukrainian Institute on Public Health Policy” (UIPHP) is a non-governmental, not-for-profit organization, founded in 2003. UIPHP was established by addiction treatment physicians and psychologists and aim to develop and implement modern approaches to public health. At that time, UIPHP was working mainly on issues relevant to HIV/AIDS prevention and drug abuse treatment Steadily, UIPHP started to enlarge its areas of expertise and involvement that is now covering wide range of communicable and noncommunicable diseases (NCDs), health system strengthening, and promotion of health through life-course.
UIPHP has longstanding and successful relationships with key stakeholders in Ukraine and internationally, which created unique opportunities to address the multiple public health issues through leveraging the resources of various governmental, non-governmental and international partners. Among the main collaborators of the UIPHP are: the Ministry of Health of Ukraine (MoH), the Public Health Center of the MoH Ukraine, All-Ukrainian Narcological Association, USAID, CDC, WHO, as well as two largest NGOs working in the area of HIV prevention and treatment (Alliance for Public Health and All-Ukrainian Network of PLWH). Since 2007, the UIPHP has been conducting joint research with Yale University, University of Pennsylvania, and University of Colorado (all USA), as well as NIH (NIDA and NIAID)-supported 074 HPTN study.
UIPHP employs 25 full-time employees and 2 part-time employees, including one professor (doctor of medical sciences), three PhDs, three MPHs, seven MDs, four Humphrey fellows, two NIDA INVEST Drug Abuse Research fellows, one Fulbright fellow, two masters on psychology.
The area of rented office of UIPHP is 268.7 square meters.
Since 2006, UIPHP have been advocacy leader in overcoming resistance of the Government, medical doctors and law enforcement officials to opioid agonist treatment (OAT). Major areas of work have included piloting new interventions and provision of training and methodological support to medical and research staff. The UIPHP was the first organization in Ukraine to train 32 Ukrainian physicians and administrators on the treatment of HIV and opioid dependence when buprenorphine was introduced into the country as primary and secondary HIV prevention. Since then, the team has continued training individuals on issues related to urban health, HIV, tuberculosis, health services research and addiction medicine. Since 2006, UIPHP has been a home to the Ukrainian OAT Resource Center, which provides comprehensive support to medical institutions and multi-disciplinary teams, which started the implementation of OAT. Until recently the Resource Centre was responsible for the collection of national statistical data on OAT – the function now performed by the UCDC. During this time - when the UIPHP served as the OAT Resource Center - the number of OAT patients in Ukraine increased from 0 to nearly 8,500. Since 2006 UIPHP has been assisting the Ministry of Health specialists in the development of the official guidelines, special orders, instructions and other normative documents. In particular, the UIPHP experts were leaders in the development of national clinical guidelines, protocols, and recommendations, including: 1) “Opioid substitution therapy (OST) in treatment of patients with the syndrome of opioid addiction” (Guidelines; MoH Order #645 of 10.11.2008); 2) “Social and psychological rehabilitation within OST programs” (Guidelines, 2007); 3) “Implementation of OST in Ukraine” (Kyiv, 2009); 4) “Treatment of opioid addiction with the antagonists of opiates” (Recommendations, 2012); 5) “Substitution therapy with the agonists of opiates” (Recommendations, 2012); 6) “Treatment of drug addiction in Ukraine and assessment of its effectiveness”; 7) “Introduction of integrated services for drug addicted persons in health care facilities” (Manual, 2010); and 8) “Impact of the OST program on the criminal situation in the country” (analytical report); etc.
In collaboration with the Ministry of Health, UIPHP conducted four Ukrainian conferences on current issues of the OAT in Ukraine: in 2006, 2007, 2009, and 2011. In 2012, the first national strategy related to substance use was developed and later adopted under the leadership of UIPHP in collaboration with the Ukrainian State Service on Drug Control with the involvement of experts and broad public participation.
UIPHP has an extensive history of running studies in which evaluate the engagement of most-at-risk populations with medical care as well as the effectiveness and cost-effectiveness of behavioral interventions to improve access and adherence to care. The following studies were conducted:
The UIPHP, in collaboration with University of Colorado (USA), conducted a research study “Peer Leaders as HIV Risk Reduction Change Agents Among IDU’s in Ukraine,” study period: 2010-2015.
In the observational cohort study “Role of Methadone Maintenance Therapy in Improving of the Adherence to TB Treatment among People who Inject Drugs in Ukraine” financed by OSI through the International Renaissance Foundation (201 –2013), we compared the outcomes of tuberculosis (TB) treatment among IDUs who receive and do not receive opioid substitution treatment (OST). These outcomes of interest included: 1) adherence to TB treatment medications; 2) retention in TB treatment. Overall, 120 IDUs diagnosed with TB were followed over the course of 6 months (60 participants of the intervention group (OST) and 60 in the control group (non-OST). All study participants received outpatient TB treatment. The study results demonstrated significantly higher retention in TB treatment among the group receiving OST. The protocol and instruments for this study were adopted and developed by the UIPHP with an expert support from Prof. Frederick L. Altice (Yale University, USA).
In 2010-2012, the UIPHP implemented the study “Adherence to antiretroviral treatment among IDUs receiving methadone substitution therapy in Kyiv”. The aim of this project was to adapt and test models "Steps to Life" as a way of ensuring adherence to antiretroviral therapy (ART) among HIV-positive IDUs SMT who were simultaneously receiving ART (50 HIV positive subjects who receive ART were included into the study). This study was funding by University of Pennsylvania, USA, main investigator Prof. George Woody.
The UIPHP also has experience in conducting studies assessing cost-effectiveness of health services delivery and treatment models. For instance, in 2010 the "Study on the cost-effectiveness of two models of therapy for opioid dependence in Ukraine" was performed with the financial support of WHO/Ukraine.
The UIPHP has conducted an Implementation Science study “Assessment of the implementation and effectiveness of the Street SMART Intervention in Ukraine” financed by Pact Inc (RESPOND) (September 2013 – May 2015). This study seeks to evaluate the implementation of the Street SMART evidence based behavioral intervention (EBI) in the Ukrainian context in order to determine its feasibility and effectiveness. The study has been conducted in Mykolaiv and Odessa Regions in collaboration with local NGOs. Preliminary results demonstrate that this EBI can be implemented with fidelity in the Ukrainian context and reduces HIV-risk behaviors while increasing knowledge on HIV transmission.
The UIPHP has conducted an Implementation Science study “Assessment of the feasibility and effectiveness of the Project START in Ukraine” financed by Pact Inc (RESPOND) (September 2013 – May 2015). The goal of this study is to evaluate the implementation in the Ukrainian context of the START intervention, which combines HIV/hepatitis/STI prevention case management, motivational interviewing and incremental risk reduction to aid soon-to-be-released prisoners to successfully re-integrate into the community and to protect them from HIV-related risks. The study has been conducted in the Mykolaiv, Lviv, and Dnipropetrovsk regions, including Mykolaiv and Kryvyi Rig cities, in collaboration with the local partners: local HIV-servicing NGOs and health care facilities.
Since 2013, the UIPHP is implementing CDC-funded U01_GH000752-01 randomized controlled trial “Enhancing Linkage to HIV Care for newly Detected HIV-Positive Persons in Ukraine”. This study assesses the effectiveness of the MARTAS - Modified effective “Anti-Retroviral Treatment and Access to Services” (ARTAS) intervention. This is a case management—based individual-level, multi-session intervention for people who are recently diagnosed with HIV in narcology, TB, and STIs clinics in order to help them link to and be retained in HIV care. It is being implemented in the Mykolaiv, Odessa, and Dnipropetrovsk regions, including Kryvyi Rig.
Since 2014, the UIPHP is the only site in EECA of the NIH-supported HIV Prevention Trials Network (HPTN) 074 Study – “A Study of the Integrated treatment and prevention for people who inject drugs: A vanguard study for a network-based randomized HIV prevention trial comparing an integrated intervention including supported antiretroviral therapy to the standard of care.” HPTN 074 is a multi-site, two-arm, randomized, vanguard study. The purpose of this study is to determine the feasibility of a future randomized clinical trial (RCT) trial that will assess whether an integrated intervention combining psychosocial counseling and referrals for ART and substance use treatment for HIV-infected PWID will reduce HIV transmission to their HIV-uninfected partners, as compared to the routine care dictated by national guidelines for HIV-infected PWID.
During these projects implementation, packages of research tools were adopted and used in Ukrainian context, or were developed and tested based on the validated research tools. These research instruments included: semi-structured questionnaires for qualitative interviews and focus groups; self-reporting forms for participants of quantitative studies, as well as forms for monitoring and evaluation.
Highest technical expertise and access to up-to-date evidence within country and internationally has made UIPHP an important player in public health policy-making in Ukraine. Key UIPHP staff are the members of MoH technical working groups on NCDs, HIV prevention, OAT and M&E, providing input to the development of national policies and strategies, as well as grant applications. The examples include the National Drug Policy, Country applications to GF rounds 6 and 10, National Hepatitis Elimination Strategy, and National AIDS Programs (2009, 2014, 2019).
Since 2015 UIPHP started to engage into relevant NCD areas such as alcohol abuse, mental health and reduction of NCD risk factors. The organization played a crucial role in the development of National Concept and Action Plan on mental health, as well as relevant advocacy activities for policy change. In addition, UIPHP took active role in providing evidence briefs for policy making that laid a foundation for further intesectoral National NCD Action Plan development that is covering strategies to tackle five NCD risk factors (tobacco, alcohol, healthy nutrition, physical activity and air pollution) and five diseases (cardiovascular, mental and chronic lung diseases, diabetes and cancers).
Over 2017-2018, UIPHP designed and implemented comprehensive evaluation of clinical practice in preventing and managing NCDs at primary health care level. The results were presented by UIPHP at the National NCD conference providing important data on NCD health care provision and recommendation for its further quality improvement.
In 2018, according to the results of the National Philanthropists Rating, UIPHP became a winner in the nomination «Expenses in Health Care», and entered the top ten leaders among all the participants of the Rating by the amount of money spent on charity.